阻塞性睡眠呼吸暂停低通气综合征行腭咽成形术围手术期的临床研究

目的探讨腭咽成形术(uvulopalatopharyngoplasty,UPPP)治疗中、重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)围手术期的临床处理.方法对54例中、重度OSAHS患者实施了腭咽成形术,围手术期的处理包括(1)多道睡眠监测和心肺功能评估;(2)术前44例、术后29例行正压通气治疗;(3)静脉诱导吸入全身麻醉46例,局部浸润麻醉8例;(4)42例行保留悬雍垂的改良腭咽成形术.结果术前未接受CPAP治疗的局麻患者术中出现短暂呼吸困难2例,术后高血压危象、心动过速各1例,术后原发性出血2例.CPAP治疗组在麻醉清醒期及术后无急性上气道阻塞发生.全身麻醉5例插管困难,有高血压病史的19例术中血液动力学波动大.经典腭咽成形术后1周内腭咽关闭不全4例,行保留悬雍垂的改良腭咽成形术后咽部有异物感9例,但无其他并发症.结论充分认识UPPP 手术存在的潜在风险,认真进行围手术期的正确治疗有助于减少手术并发症,提高手术和麻醉的安全性.     

245例悬雍垂腭咽成形术后并发症及防治体会

阻塞性睡眠呼吸暂停低通气综合征(OSAHS),由于其发病率、死亡率逐渐增高,而引起多学科医生的重视.其主要的治疗方式是外科手术治疗,而保留悬雍垂的腭咽成形术是治疗以腭咽平面为主要阻塞部位的OSAHS患者的主要术式[1].但其术中及术后有较多并发症,且风险大而引起人们的重视.我科自2008年1月～2010年5月共行悬雍垂腭咽成形术245例,现将并发症及预防措施总结如下.     

改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征临床疗效探讨

目的改进经典的悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)手术方法,探讨提高阻塞性睡眠呼吸暂停低通气综合征(obstructivesleepapneahypopneasyndrome,OSAHS)的疗效,减少术后并发症的方法.方法对OSAHS54例行改良UPPP;术后6、12、24个月随访,每次随访均行多导睡眠监测仪(polysomnography,PSG)测定.参照杭州会议(2002年)标准评定疗效.结果患者打鼾、憋气、头痛及嗜睡等症状均于6个月内明显减轻或消失,经PSG监测,总有效率为100%.术后12、24个月经PSG监测,其疗效分别为100%和96.29%.结论此术式可有效地扩大腭咽腔的通气面积,保持软腭的紧张度及咽黏膜的正常功能;减少术后并发症的发生,提高了手术疗效.     

减少悬雍垂腭咽成形手术术中及术后出血的临床研究

阻塞性睡眠呼吸暂停低通气综合征(OSAHS) 发病率甚高,保留悬雍垂的腭咽成形术仍是治疗以腭咽平面为主要阻塞部位的OSAHS患者的主要术式[1].出血是最常见的并发症之一,如何减少术中及术后出血是人们最关心的问题.如处理不当有引起大出血、窒息甚至死亡的危险,为探讨有效减少术中及术后出血的手术及围手术期治疗的方法,我们对2009-01-2009-10 治疗的行保留悬雍垂的腭咽成形术患者共70例进行研究分析[2].     

悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征

目的探讨提高阻塞性睡眠呼吸暂停低通气综合征(OSAHS)手术疗效的方法.方法OSAHS患者30例,19例全麻下及11例局麻下完成悬雍垂腭咽成形术(UPPP),其中3例行预防性气管切开术.结果术后随访半年,结果治愈6例(20%),显效12例(40%),有效6例(20%),无效6例(20%),总有效率为80%.术中出现呼吸障碍2例,术后扁桃体出血1例,暂时性腭咽功能不全6例.结论悬雍垂腭咽成形术麻醉方法的正确选择、术前预防性气管切开的应用,有助于提高手术疗效,减少并发症的发生.同时,阻塞部位的术前准确定位及手术方案设计、手术技巧也是重要因素.     

改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征及重度鼾症12例

悬雍垂腭咽成形术 (UPPP)治疗阻塞性睡眠呼吸暂停综合征 (OSAS)及重度鼾症已被广泛采用。发生大出血及鼻咽狭窄等并发症的报道已不鲜见 ,悬雍垂保留与否意见不统一。本文就术中、术后并发症的预防及悬雍垂的处理进行一些探讨。1　资料与方法1 .1　临床资料1 2例均为男性 ,年龄 2 4～ 68岁 ,平均 41岁。患者均有较响的鼾声 ,妨碍同室人睡眠 ,软腭长度为35～ 41 mm,扁桃体均 ～ 度。经多导睡眠呼吸监测呼吸紊乱指数 (AHI) 38～ 54,其中 8例呼吸暂停指数 (AI) >5。软腭松弛状态 :下腭咽横径 (悬雍垂根部水平咽腭弓之间的距离 )为 9.5～…     

应用射频术与悬雍垂腭咽成形术治疗OSAHS患者近期疗效比较

目的 评价低温等离子射频术(temperature controUed radiofrequeney,TCRF)和悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)治疗阻塞性睡眠呼吸暂停低通气综合征(obstructivesleep apnea-hypopnea syndryome,OSAHS)一期患者的手术疗效和术后并发症.方法 选择阻塞性睡眠呼吸暂停低通气综合征FriedmanM临床分期一期患者60例,随机分TCRF术组和UPPP术组,每组各30例.术后6个月行多导睡眠图分析(polysomnography,PSG),然后对两组患者术前术后PSG监测指标及术后并发症进行统计学分析.结果 临床症状的消除和PSG监测结果两组比较无统计学意义.言语功能的改变、腭咽关闭不全严重并发症上两组无明显差异.但在术后疼痛、恢复正常饮食、术后出血、咽部异物感有明显差异.结论 与UPPP术组相比较,TCRF术治疗OSAHS一期患者手术疗效相似,但并发症明显减少.     

腭咽成形术中保留悬雍垂的意义

目的　改进经典悬雍垂腭咽成形术 (uvulopalatopharyngoplasty ,UPPP)手术方法 ,探讨术中保留悬雍垂的意义 ,提高UPPP手术疗效、减少术后并发症。方法　治疗睡眠呼吸暂停综合征患者 30例。①在主观症状改善的基础上 ,应用多导睡眠图分析及咽腔解剖参数测量等项指标 ,术后随访 6个月以上 ,对术前术后所获资料进行统计学分析。②手术改进特点 :力求维持咽腔正常生理解剖形态 ,完整保留悬雍垂 ,解剖切除腭帆间隙脂肪组织 ,扩大软腭成形范围 ,平均软腭切除最高点在悬雍垂根部两侧上 1 9cm。结果　主观症状明显改善者占 87 0 % ,以AHI下降 >5 0 %为判定标准 ,有效率为5 3 3 % ,对轻、中度患者 (AHI<5 0 )有效率达 73 3 % ,无 1例出现腭咽关闭不全、咽腔瘢痕狭窄、误咽等并发症。术后咽腔解剖测量 :完整保留的悬雍垂术后 2周左右开始回缩 ,3～ 6个月接近并达到正常水平。结论　此术式可有效扩大咽腔 ,避免腭咽关闭不全等并发症 ,提高UPPP手术疗效 ;完整保留的悬雍垂依靠术后悬雍垂肌、腭帆提肌、腭帆张肌的运动及两侧软腭愈合引起的向上向外的牵拉作用 ,可以逐步回缩至正常生理水平     

“Z”形腭咽成形术治疗睡眠障碍和鼾症

阻塞性睡眠呼吸暂停综合征(OSAS)常规采用悬雍垂腭咽成形术(UPPP),该术式的目的是通过切除悬雍垂及腭咽以扩大咽腔。由于切除了悬雍垂,术后并发症较多,如咽部狭窄、食物返流至鼻腔、咽鼓管功能紊乱等,且手术需在全麻下进行。为此,该作者介绍了一     

阻塞性睡眠呼吸暂停低通气综合征的改良术式

目的 改良悬雍垂腭咽成形术方法,保留悬雍垂,对软腭和咽侧壁进行处理和成形。 方法 手术治疗阻塞性睡眠呼吸暂停低通气综合征患者263例。手术改 良方法要点：维持咽腔正常解剖生理形态,保留悬雍垂,切除腭帆间隙脂肪组织,对软腭和咽侧壁进行成形, 以充分扩大咽峡和鼻咽峡。 应用多导睡眠图分析,术后随访6个月以上,对术前和术后资料进行统计学分析。结果 263例患者均进入结果分析。(1) 术后不需镇痛药197例(74.9%),需要镇痛药66例(25.1%),咽侧壁光滑168例(63.9%),部分裂开95例(36.1%),术后均无憋气及鼻腔返流等并发症; (2) 均随访6个月以上,无吞咽返呛、开放性鼻音等并发症。95例(36.1%)有咽部异物感,189例(71.9%)睡眠呼吸暂停症状消失,74例(28.1%)仍有症状,但均较术前改善。 术后口腔形态满意252例(95.8%),不满意11例(4.2%); (3) 术前与术后多导睡眠监测结果各项指标比较, 差异均有统计学意义(P均<0. 05)。 结论 改良悬雍垂腭咽成形术可充分扩大咽腔空间,避免并发症,提高手术疗效。     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.